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FEC Form 1 for American Health Care Association Political Action CommitteeForm 1 for American Health Care Association Political Action Committee

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-195578

1. American Health Care Association Political Action Committee

    1201 L Street NW
    Washington, DC 20005
    Email: alee@ahca.org

2. Date: 06/09/2005

3. FEC Committee ID #: C00006080 This committee is a Separate Segregated Fund

Affiliated Committees/Organizations

Custodian of Records:


Treasurer:

Robert Van-Dyk-Treasurer
1201 L Street NW
Washington, DC 20005

Designated Agent(s):

Anna Lee
1201 L Street NW
Washington, DC 20120
Title: Assistant Traesurer
Phone # (202) 898-2856

Banks or Depositories

BB&T
PO Box 819
Wilson, North Carolina 27894

Signed: Robert Van-Dyk-Treasurer
Date Signed: 06/09/2005

(End FEC FORM 1)


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